Camp Programs for Synagogues and Schools

1. Name of person completing form*

First

Last

2. Email Address*

3. Cell Phone*

4. Name of the synagogue or school*

5. Select the camp that will be presenting the program*

Other (Please Specify)*

6. Description of program and target audience*

7. Date (or approximate date) of the program*

8. Describe how the camp will be connected with parents for at least 5-10 prospective camp families of the hosting community*

8. Amount of subsidy requested (up to $200)*

9. Name of organization to which subsidy is to be paid

10. Street address of organization*

City

State

ZIP Code

Please include any other relevant information